Depressive Disorders

Depressive disorders are characterized by low moods, feeling blue, or having apathy on exposure to a painful situation such as loss, disappointment, relationship problems, financial difficulties, and/or trauma. Bereavement, also known as grief, is differentiated from depression, in that bereavement is a normal reaction to the loss of a loved one and short-lived, whereas depression is more chronic, impacts your functioning, and lingers even with time passing. In addition to bereavement, sadness is a normal response to painful situations, where sadness is short-lived, while depression lingers and impacts your functioning. Both bereavement and sadness can turn into depression if the depressive symptoms linger past 2 weeks and you have multiple symptoms which impact your functioning.

Depression can occur when you are presented with a painful situation, and you start thinking negatively about the situation and about yourself. In response to the painful situation, you may think the situation is hopeless, you may think you are worthless, you may have no hope for the future, and/or you may think nothing will change. This negative thinking may then lead to feeling depressed. Depression may also be associated with other feelings, like shame, guilt, anger, or anxiety. Your self-esteem may also be low, you may not find pleasure in things, you may have difficulty concentrating, and you may have no hope for the future, to the point where you may also have thoughts of suicide. In addition to feeling low moods, you may have physical sensations of depression, including fatigue, exhaustion, lethargy, sleep disturbance, appetite changes, body pains, and headaches. Because you are depressed from the negative thinking and have fatigue, sleep problems, pain and eating problems, you tend to do less and less. Soon, you start to isolate and stop doing the things that used to bring you pleasure. You may also stop going to work, stay in bed, and ignore your relationships. These isolating behaviors in turn make you feel more depressed, getting you caught up in a vicious cycle of depression.

Depression, also called major depressive disorder, occurs when the depressive symptoms cause impairment of your functioning in relationships and work/school. The major depressive disorders include major depressive disorder, dysthymic disorder, and bipolar depression. Other depressive disorders include substance induced mood disorder, mood disorder due to a general medical condition, adjustment disorder with depression, minor depressive disorder, recurrent brief depressive disorder, and premenstrual dysphoric disorder. The major disorders are associated with the following:

Major depressive disorder- low moods or anhedonia with other symptoms of depression for at least 2 weeks

Dysthymic disorder- chronic depression for at least 2 years

Bipolar depression- depression that occurs in bipolar disorder

Depression treatment involves psychotherapy, with cognitive behavioral therapy (CBT) having the most evidence for efficacy. CBT works on the premise that events or situations do not directly cause the depression; rather, the thoughts we have or the meaning we give the events causes the depression. CBT works by identifying the maladaptive thoughts, working on more adaptive thoughts, and suppressing/distancing oneself from the maladaptive thinking. In addition, CBT addresses the avoidant and isolative behaviors which serve to sustain the depression over the long term. Other forms of psychotherapy include depth or insight oriented psychotherapy, which addresses the causes and the proximal determinants of the depression. If psychotherapy is not effective, or if the depressive symptoms are severe, then pharmacotherapy with depression medications can be considered after a psychiatric assessment. Other treatments for depression include self-help treatments, natural supplements, and alternative interventions for depression like exercise, meditation, and diet. If you are experiencing severe depressive symptoms or have suicidal thoughts, please contact your doctor immediately.